Complications after discharge with COVID-19 infection and risk factors associated with development of post-COVID pulmonary fibrosis,Respiratory Medicine

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Complications after discharge with COVID-19 infection and risk factors associated with development of post-COVID pulmonary fibrosis
Respiratory Medicine ( IF 4.3 ) Pub Date : 2021-09-08 , DOI: 10.1016/j.rmed.2021.106602
Dr Raminder Aul ₁ , Dr Jessica Gates ₁ , Dr Adrian Draper ₁ , Dr Anne Dunleavy ₁ , Dr Sachelle Ruickbie ₁ , Dr Helen Meredith ₁ , Dr Nicola Walters ₁ , Dr Cristiano van Zeller ₁ , Dr Victoria Taylor ₁ , Dr Michael Bridgett ₁ , Dr Roisin Dunwoody ₁ , Dr Sisa Grubnic ₁ , Dr Tersesa Jacob ₁ , Dr Yee Ean Ong ₁

Affiliation

Introduction

Survivors of COVID-19 infection may develop post-covid pulmonary fibrosis (PCF) and suffer from long term multi-system complications. The magnitude and risk factors associated with these are unknown.

Objectives

We investigated the prevalence and risk factors associated with PCF and other complications in patients discharged after COVID-19 infection.

Methods

Patients had phone assessment 6 weeks post hospital discharge after COVID-19 infection using a set protocol. Those with significant respiratory symptoms were investigated with a CTPA, Pulmonary Function Tests and echocardiogram. Prevalence of myalgia, fatigue, psychological symptoms and PCF was obtained. Risk factors associated with these were investigated.

Results

A large number of patients had persistent fatigue (45.1%), breathlessness (36.5%), myalgia (20.5%) and psychological symptoms (19.5%). PCF was seen in 9.5% of the patients and was associated with persistent breathlessness at 6 weeks and inpatient ventilation [adjusted OR 5.02(1.76–14.27) and 4.45(1.27–15.58)] respectively. It was more common in men and in patients with peak CRP >171.5 mg/L, peak WBC count ≥12 × 10 9/L, severe inpatient COVID-19 CXR changes and CT changes. Ventilation was also a risk factor for persisting fatigue and myalgia, the latter was also more common in those with severe cytokine storm and severe COVID-19 inpatient CXR changes.

Conclusions

All the patients discharged after COVID-19 should be assessed using a set protocol by a multidisciplinary team. Patients who had severe COVID-19 infection particularly those who were intubated and who have persistent breathlessness are at risk of developing PCF. They should have a CT Chest and have respiratory follow-up.

中文翻译：

感染 COVID-19 出院后的并发症以及与 COVID-19 后肺纤维化发展相关的危险因素

介绍

COVID-19 感染的幸存者可能会发展为 covid 后肺纤维化 (PCF)，并患有长期的多系统并发症。与这些相关的严重程度和风险因素尚不清楚。

目标

我们调查了 COVID-19 感染后出院患者中与 PCF 和其他并发症相关的患病率和危险因素。

方法

患者在感染 COVID-19 后出院 6 周后使用既定方案进行电话评估。那些有明显呼吸道症状的人接受了 CTPA、肺功能测试和超声心动图的调查。获得了肌痛、疲劳、心理症状和 PCF 的患病率。调查了与这些相关的风险因素。

结果

大量患者有持续性疲劳（45.1%）、呼吸困难（36.5%）、肌痛（20.5%）和心理症状（19.5%）。PCF 见于 9.5% 的患者，并与 6 周时的持续呼吸困难和住院通气相关 [调整后的 OR 分别为 5.02(1.76–14.27) 和 4.45(1.27–15.58)]。它在男性和峰值 CRP >171.5 mg/L、峰值 WBC 计数≥12 × 10 9/L、严重住院 COVID-19 CXR 变化和 CT 变化的患者中更为常见。通气也是持续疲劳和肌痛的危险因素，后者在严重细胞因子风暴和严重 COVID-19 住院患者 CXR 变化的患者中也更常见。